FAQ Category: Knee

Excellent health is probably the biggest and best predictor of results after total knee replacement (TKR). Numerous studies show a direct link between health before an operation and results after the surgery.

Patients who rate their health as “poor” are four to five times more likely to die. This is true despite differences in background, disease severity, and other psychologic or social issues.

A recent study at the University of Kansas in Wichita confirmed these findings for TKR patients. Those who rated their health as “good” to “excellent” had the best outcomes. Their health status improved dramatically from before to after the operation. Joint stiffness, pain, and function were used to measure health status.

The authors of the study pointed out that all their patients came from one orthopedic practice. Their results may not be the same for other groups.

You ask a very good question. Researchers are always looking for ways to predict results for various diseases or surgeries. In the case of a total knee replacement (TKR), pain, stiffness, and physical function before surgery can be measured. There’s a specific test called the WOMAC Arthritis Index that may be helpful.

Patients who get a low score (meaning poor health) often have the worst results after TKR. Patients with scores that show good to excellent health have the best results.

Your doctor is right though. Even if the test predicts a poor outcome, the final decision is the patient’s. Counseling may be helpful if there is a psychologic reason for your mother-in-law’s behavior. You may want to bring this idea up to the doctor if you can’t discuss it directly with the patient.

You didn’t say your mother’s age but age may be a factor. Older women are at increased risk for this problem. There’s an increased number of these fractures in women who are postmenopausal. Osteoporosis (decreased bone density) in this age group is another important factor.

Without its normal resiliency, the simplest, everyday stress can cause damage to the bone. Anyone who has arthritis is also at increased risk. Often, the osteoporosis added to any slight knee deformity can be enough to cause this problem.

Other factors include alcohol use, Crohn’s (intestinal) disease, and the use of steroids for arthritis. Low calcium absorption, vitamin D deficiency, and hormonal changes are also factors.

Informed consent is the process of telling the patient what will happen during surgery. The doctor or assistant also goes over any possible risks and problems that can happen. Everything should be explained at the patient’s level in easy terms that can be understood easily.

The patient can ask any questions he or she may have at that time. That’s the “informed” part of informed consent.

The consent is the patient’s signature on a form stating that he or she understands the information and agrees to the surgery. The patient’s signature shows that it is a voluntary act on the part of the patient.

Offer to stay with your mother-in-law during the appointment. Make sure she fully understands what she’s signing.

Pain around the knee after traumatic hip dislocation is often caused by a bone bruise. The force of the impact through the knee may cause tiny fractures. These occur just under the cartilage in the first layer of bone called subchondral bone.

Bone bruises can also occur as a result of falls, sports injuries, or a direct blow to the knee from people or objects. Bruises can be painful (mild to severe) and last from days to months.

MRI shows swelling inside the bone marrow as a sign of a bone bruise. The injury usually heals on its own without treatment. Surgery may be needed if there’s a large fracture of any of the bones around the knee.

It could be either or none of those explanations. It’s best to have it checked out before
further injury or damage occurs.

A study done by orthopedic surgeons in Pittsburgh, Pennsylvania, showed a high rate (93
percent) of knee injuries after traumatic hip dislocation. Most of the patients in the
study were in a car accident. A few had other traumatic injuries.

The knee injuries ranged from microfractures of the bone (bone bruise) to ligament
injuries to meniscal tears. Bone bruising will likely heal on its own. Ligament damage

It could be either or none of those explanations. It’s best to have it checked out before further injury or damage occurs.

A study done by orthopedic surgeons in Pittsburgh, Pennsylvania, showed a high rate (93 percent) of knee injuries after traumatic hip dislocation. Most of the patients in the study were in a car accident. A few had other traumatic injuries.

The knee injuries ranged from microfractures of the bone (bone bruise) to ligament injuries to meniscal tears. Bone bruising will likely heal on its own. Ligament damage can lead to an unstable knee. Serious meniscal tears may need repair to prevent osteoarthritis later.

Make an appointment with your doctor soon and find out what’s going on. Early treatment can prevent long-term problems later.

You are both right. Up until age 90, more women than men have total knee replacements (TKR). According to a study of Medicare claims for adults over age 65, two-thirds of the TKRs were done in women. One-third were men. Presumably this is because more women have arthritis than men do.

Fewer women have TKRs as they get older because older women are more likely than older men to be living alone. Lack of family or social support might explain fewer numbers of older women having TKR.

Our sincere condolences in your loss. Any and all operations (even the simplest) have a certain risk. Death is always one of those risks.

A recent study of Medicare claims for adults age 65 and older lists death rate for primary total knee revision as 0.7 percent. This is a very low figure. The death rate after a revision surgery was almost double that (1.1 percent) but still very low.

Complications during the 90 days after surgery are low but serious. Pneumonia, blood clots, infection, and heart attack are the most common.

As more and more people have this operation there will be fewer overall complications but more people affected.

Of the more than 350,000 total knee replacements (TKRs) done last year, 29,000 had to be revised. That’s less than 10 percent (around eight percent).

Studies show black men in the lower economic ranks are the most likely to have revision surgery. This group is more likely to have complications in general. The reasons for this are unknown. It could be patient-related or it may be the quality of care at the hospitals or centers where the TKRs are done. More studies are needed to solve this mystery.

The rate of complications increases as patients get older. The risk of deep wound infection is much greater after TKRs compared to hip replacements.

So whether it’s your gender, age, race, or economic status, you’re not alone. It doesn’t happen very often, but revision after TKR isn’t rare.

You can but it’s not always a good idea. A recent study of 19 high-level athletes with an ACL injury showed they could get back to training without surgery in four to 14 weeks. The minimium after ACL repair is 12 to 16 weeks and often longer.

The down side of bypassing the recommended ACL repair is well documented. Studies show joint instability after ACL rupture leads to meniscus problems. The meniscus functions to transmit loads through the joint and hold it stable.

Once the meniscus is impaired then the joint cartilage is overloaded and damaged. The next step is the release of enzymes that destroy the layer of bone underneath the cartilage. All of this leads to arthritis of the knee.

Researchers have not explored this type of connection in humans. Believe it or not, it’s discussed much more in the animal world, especially among dogs. Athletic breeds of dogs are at risk for ACL tears.

Animal experts say that while some ACL injuries are simply a case of the dog being in the wrong place at the wrong time, there is also some strong evidence that there are genetic components to the tendency toward ACL tears and ruptures.

Hereditary hypermobility of joints has been named as a possible cause of ankle sprains. Without a strong ligamentous support system, joints may be at increased risk for injury. Whether or not this is true for the ACL is not known at this time.

Well, there’s some truth to your statement but there are many factors in between those two points. First it depends on how severe the damage is to your anterior cruciate ligament (ACL). A minor tear can be treated with rehab. This is especially true if you’re not an athlete or exercising at intense levels.

Studies do show a tendency toward cartilage damage in unstable knees. This means the ACL is deficient and not doing its job. The joint slides around more than it should, putting stress on the meniscus and other joint cartilage. Under the increased load, wear and tear on the meniscus could end up in a tear.

Only one study has been done that shows the need for a total replacement (TKR) after ACL injury without repair. A small group of olympic athletes in the former East Germany were treated without surgery and returned to training. Doctors followed them 35 years later and found out that all of them had a torn meniscus. Half had a total knee replacement.

Long-term studies of everyday average people with an unrepaired ACL have not showed these kinds of results. They do report an increased pattern of osteoarthritis in the unstable (unrepaired) knees. The risk of a TKR is present but not a certainty.

Yes! There are written materials available. Doctors often have pamphlets and brochures to explain most types of common surgeries. You may want to take the time to get some of these materials from the doctor’s office. Sit down with your mother-in-law to review them together.

Some patients don’t like their family to interfere. You may need to express interest in the operation by reading the materials yourself. Perhaps reading important parts of the information out loud will help.

There are even some videos out now but they may not have closed-caption yet. Adapted materials may become part of future patient instruction as more and more older adults with hearing and vision problems have surgery.

You have a very real concern. Your father will be filling out forms at the doctor’s office. Then there will be more forms at the hospital or center where the surgery will be done. You may want to go with him. Make sure he understands what he’s reading and signing.

Sometimes the doctor has a video patients can watch. For example the American Academy of Orthopaedic Surgeons puts out a video called Arthroscopic Knee Surgery: Return to Action. Watching a video helps increase patients’ understanding of surgery and what’s expected.

It may be helpful if you can let the doctor and therapists who will be working with your father know of your concerns. Extra effort can be made to make sure verbal and written instructions are given at his level of understanding.

A study done by researchers at the Joint Replacement Institute in Los Angeles, California, used the following guidelines to calculate activity level. This may help you:

The 10 to 15 year time period associated with joint implants is based on the law of averages. Using long-term studies of patients, researchers have been able to report the ranges of time that joint replacements have lasted.

We’ve discovered from these studies that it’s not really a function of time. It all depends on the amount of use that occurs. The more physically active you are, the short the life of your implant.

There’s no internal mechanism keeping track of the number of steps you’ve taken. No microchip to signal the end. It’s just a gradual process of wear and tear. The plastic components start to get thin. The metal portions may shed tiny particles that build up inside the joint causing damage.

The first signs of problems developing may be knee pain or joint clicking. See your doctor early on before the symptoms get worse. In some cases, it’s possible to revise the joint without replacing the whole thing.

There are several things to think about here. First, research shows that video feedback is a valuable learning tool. Combining self-video with videos showing experts doing the task may be the best way to change one’s own methods of doing something and improve the technique.

So, first get a baseline of your athletes; videotape them making jump-landing shots. Catch the action from all angles and even from above if you can. Choose one key area to work on. Say for example, you want the athlete to work on softer landings. Provide an “expert” video showing how to land a jump.

Narrate the tape and give the athlete a checklist of things to work on:

Videotaping is an ideal tool to use as proof of “before” and “after” so-to-speak. During the school year or before heading off to camp, have a friend or family member videotape your form and skills as you play against an opposing team.

Watch the video and choose one or two areas you’d like to work on during training. When you come back from camp, revideo yourself and compare the two. Use the slow motion feature available on most video cameras to study angles, joint motion, hand and foot position, or any other feature.

You may even want to videotape the experts at the camps you attend (with their permission). This would give you a chance to review the movements throughout your training season. Try to set up two TV screens. You can watch yourself perform an action such as a jump, serve, or basket while viewing the teaching video at the same time.

There is some research suggesting hip, knee, and ankle alignment is a key to preventing ACL injuries. Landing on both feet equally with the knees in neutral (not too far in or out) may be crucial. Landing on the balls of the feet and rocking backward may be a good training tip. And as you suggested, using the right amount of hip and knee flexion when landing a jump could prevent ACL tears.

Like many things it may be best to look at this problem on a continuum. To the far left of the line is No Play/No Injury. That’s not an option for the athlete. To the far right is Play Hard/Use Any Form. In between may lay the secret to success. Combining the right injury prevention strategies while still enhancing performance is the balance to seek.

As with every new skill, training and practice make a difference. Repeating a new skill over and over is more likely to incorporate it into the athlete’s natural form. The athlete may not use perfect form during every play in the game but the chances of injury
may be less with overall improved technique.

It’s fairly well known that patients get worse before they get better after a total knee replacement. Major deficits in strength are seen in the first month after the operation. Most likely this is because the muscles around the knee are often cut during this procedure. It takes four to six weeks for the soft tissues to heal and begin to recover.

Most patients see a remarkable improvement by the end of six months. Between one and two years post-TKR you should see small gains in function.

The best thing you can do for yourself in these next two months is to stay steady. Do your exercises faithfully every day. Don’t overdo it. More isn’t always better. Consult with your doctor and physical therapist about the best plan of rehab for your particular circumstances. Will you have to go up and down stairs at a church or banquet hall? How far will you have to walk during the ceremony?

You may want to have an escort at all times. No one needs to know that person is giving you more support than just a polite escort. Your escort can also discretely make sure a chair is available for you. Short rest breaks can help. Sitting too long may cause increased stiffness. Staying active is your best insurance for a good outcome. And congratulations!